ANNUAL REPORT TO THE ACCREDITATION REVIEW COUNCIL
ON EDUCATION IN SURGICAL TECHNOLOGY AND SURGICAL ASSISTING
(When completing this annual report please refer to the “Annual Report Instructions” provided. Incomplete or incorrectly completed reports will be returned to the program.)
SECTION I
- List all class completion dates within the academic year:8/1/2009-7/31/2010.
**Report the month/day/year of each completion date.
______
______
- School Name:______
**Please note: You must have at least one institutional accreditor (regional or national)
- Name of Institutional Accreditor (Regional): ______
- Name of National Accreditor (National): ______
- Name of Accreditor (Other): ______
- Program’s Address: ______
______
- Phone Number: ______
- Alternate Phone Number: ______
- Program Director E-Mail Address: ______
- Fax Number: ______
- Website Address (URL): ______
- Program’s ARC/STSA Approved Maximum Enrollment Cap: ____
- Actual Students Admitted: ____ (August 1, 2010-July 31, 2011)
- Program Length 1: ____ (months)
- Program Length 2: ____ (months)
- Degree Awarded 1: ______
- Degree Awarded 2: ______
- Has your program been Inactive at least one of the last two years? ______
If yes, list the year(s) you were inactive? ______
1.List all academic breaks and time off for the coming academic year:
**For time period between May 1, 2011 and April 30, 2012.
______
______
______
2.Tuition and Fees for the Program (In State): ______
3.Tuition and Fees for the Program (Out of State): ______
4.Have there been any changes in tuition and fees? Yes: ______No: ______
If yes, describe the changes: ______
______
______
______
- List Clinical Sites:
**Include the Name of the site, city, state, phone and the number of slots available specifically to the surgical technology students at your program.
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______
______
______
______
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______
- List ARC/STSA Approved Consortium Campuses (if applicable):
**Include the campus names, city and state of each campus in the consortium.
______
______
- List ARC/STSA Approved Satellite Campuses (if applicable):
**City, state and phone of each satellite campus.
Satellite Campus #1______
Satellite Campus #2______
Satellite Campus #3______
List Number of students enrolled at eachARC/STSA approved satellite campus:
Satellite Campus #1=_____ Satellite Campus #2 =_____ Satellite Campus #3=_____
8.Distance Education Delivery: Yes: ______No: ______
What is your delivery method? _____Web
_____Video
_____Combination
_____Other
9.Accelerated Alternate Delivery (AAD) Option: Yes: ______No: ______
How is the Accelerated Alternate Delivery (AAD)program offered?_____ Distance
_____Traditional
_____Combination
10.Have there been changes in the program’s curriculum?Yes: ______No: ______
(Be prepared to upload supporting documentation.)
If yes, describe the changes: ______
______
______
11.Supplies and Equipment Budget: $______
12.Capital Expenditures Budget: $______
13.Professional Development Budget: $______
14.Evaluate program specific budget, advise on changes: ______
______
______
______
15.Have there been any changes in monitoring student advancement?
Yes: ______No: ______
If yes, describe the changes: ______
______
______
______
- Have there been any changes in the communication of evaluation to students?
Yes: ______No: ______
If yes, describe the changes: ______
______
______
______
17.List program faculty (President/CEO, Dean/Administrator, Program Director, Clinical Coordinator, Program Didactic/Clinical Instructor(s), and National Program Director):
**You will need the complete name, credentials, job title, job classification (description of reportable faculty), address, phone, and e-mail for each faculty/staff member.
______
______
______
______
______
______
______
______
______
18.How are community needs assessed and monitored?
______
______
______
19.Have there been any changes in community needs?
Yes: ______No: ______
If yes, describe the changes: ______
______
______
______
20.Have there been any changes in the admission process and procedures?
Yes: ______No: ______
If yes, describe the changes: ______
______
______
______
- Which ARC/STSA approved clinical case requirement guideline for program completion does the program use?
_____Minimum (80 cases)
_____Standard (125 cases)
_____Best (140 cases)
- Enter the Student to Teacher Lab Ratio used during the laboratory skills course(s) of the program. (Example: 12:1) _____:_____
- Specifythe number of Administrative Release Hours assigned to the Program Director. This is the number of hours per week that the Program Director is released from teaching duties to perform administrative duties. ______
SECTION I
Data reported in SECTION I is for the academic year:8/1/2009- 7/31/2010
List all class completion dates within the academic year listed above:
______
______
______
Data reported in SECTION I - Retention is for the academic year: 8/1/2009 – 7/31/2010
RETENTION
Report program data for each completion date listed on page 6of this worksheet.
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Completion Date: ______
Admitted: ______Graduated: ______Graduation Rate: ______%
Please provide an analysis of retention data reported during this academic year. Provide a plan of action for improvement, if applicable.
______
______
______
______
How do retention levels compare to the past 2 years?
______
______
______
______
Data reported in SECTION I –Outcomes Assessment Exam is for the academic year:8/1/2009 –
7/31/2010
Each program should report either the PAE or CST Exam data for 8/1/2009-7/31/2010 according to the program’s approved outcomes assessment exam election for this time period.
The E-report online does not include the ability to report CST Exam outcomes. Programs reporting CST exam outcomes for the 8/1/2009-7/31/2010 must file boththe2011 Annual Report (e-report online) and the 2011Annual Report Addendum – CST Outcomes Assessment Exam Data Sheet – Surgical Technology [submitted in PDF format via e-mail to or hard copy (paper) via mail services (USPS, FedEx or UPS.)]
Program Assessment EXAM (PAE)
Report program data for each completion date listed on page 6of this worksheet.
AST Program Assessment Exam (PAE) - 5th Edition
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2011 Annual Report Worksheet 11/11
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
1 of 27
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
1 of 27
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
1 of 27
PAE 5th Edition (Continued)
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2010 Annual Report Worksheet 11/10
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
1 of 27
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2010 Annual Report Worksheet 1 of 26 1/10
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
2010 Annual Report Worksheet 1 of 26 1/10
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
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OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
1 of 27
PAE 5th Edition (Continued)
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2010 Annual Report Worksheet 11/10
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
2010 Annual Report Worksheet 11/10
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2010 Annual Report Worksheet 1 of 26 1/10
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
2010 Annual Report Worksheet 1 of 26 1/10
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
1 of 27
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
1 of 27
PAE5th Edition (Continued)
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2010 Annual Report Worksheet 11/10
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
2010 Annual Report Worksheet 11/10
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2010 Annual Report Worksheet 1 of 26 1/10
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
2010 Annual Report Worksheet 1 of 26 1/10
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
1 of 27
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
1 of 27
Completion Date ______:
Total number of students who took exam: ______
Number of students who scored “Exceptional” (86-100%): ______%
Number of students who scored “Sufficient” (70-85%): ______%
Number of students who scored “Minimal” (60-69%): ______%
Number of students who scored “Insufficient” (0-59%): ______%
2011 Annual Report Worksheet 10211
OBJ AREA %
Basic Science______
Biomedical Science______
Intraop Sterile______
Practice______
OBJ AREA %
Preop Nonsterile______
Preop Patient Care______
Preop Sterile______
Related Science______
Surgical Procedures______
2011 Annual Report Worksheet 10211
Please provide an analysis of PAE average report results reported during this academic year. Provide a plan of action for improvement, if applicable.
______
______
______
______
How do PAE levels reported during this academic year compare with the last two years?
______
______
______
______
Program Assessment EXAM (CST)
Report program data for each completion date listed on page 6of this worksheet.
CST Certification Exam (NBSTSA)
Report CST data ONLY if the program elected to transition to the CST exam as the program’s approved outcomes assessment exam for the period of 8/1/2009-7/31/2010.
NOTE: Programs who elected to transition to the CST Exam as the program’s approved outcomes assessment exam for the period of 8/1/2009-7/31/2010or previously will need to complete the PAE section of the Annual Report as outlined in the “2011 Instructions for the ARC/STSA EReport” – pages 21-23 and MUST complete and submit the following form:
2011 Annual Report Addendum
CST Outcomes Assessment Exam Data Sheet – Surgical Technology
The “2011 Annual Report Addendum: CST Outcomes Assessment Exam Data Sheet –Surgical Technology” form is included in the Annual Report packet (yellow form) and available online at .
Worksheet pages for completing this form are found on below.
Total of Completion DATES FOR academic year:8/1/2009–7/31/2010
Total number of students who took exam: ______
Total Number of students who scored “Pass” on the first attempt: ______= ______%
Report by Completion Date
Completion Date: ______
Total number of graduates: ______
Total number of graduates who took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Completion Date: ______
Total number of graduates: ______
Total number of graduateswho took exam: ______
Number of students who scored “Pass” on the first attempt: ______= ______%
Please provide an analysis of CST Exam average report results reported during this academic year. Provide a plan of action for improvement, if applicable.
______
______
______
______
SECTION II
Data reported in SECTION II is for the academic year:8/1/2008- 7/31/2009
List all class completion dates within the academic year listed above:
______
______
______
Data reported in SECTION II – Graduate Placementis for the academic year:8/1/2008- 7/31/2009
Graduate Placement
Report program data for each completion date listed on page 17 of this worksheet.
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Completion Date: ______
Graduates employed within 1 year:______
Graduates continuing education:______
Total Number of Graduates Placed:______
Total Graduates______
Graduate Placement ______%
Please provide an analysis of results reported during thisacademic year. Please provide plan of action for improvement, if applicable.
______
______
______
______
How do reported graduate placement levels compare with the last two years?
______
______
______
Data reported in SECTION II – Employer Surveyis for the academic year:8/1/2008- 7/31/2009
Employer Survey
Report program data for each completion date listed on page 17of this worksheet.
Completion Date: ______
Employer Survey Return Rate
Employer Surveys Distributed: ______
Employer Surveys Returned: ______
Employer Survey Return Rate: ______%
Employer Survey Satisfaction Rate
**A satisfactory survey must have 24 out of the 28 questions rated 3 or greater on the 5 point Likert Scale.
Employer Satisfactory Surveys: ______
Employer Surveys Returned: ______
Employer Satisfaction Rating: ______%
Completion Date: ______
Employer Survey Return Rate
Employer Surveys Distributed: ______
Employer Surveys Returned: ______
Employer Survey Return Rate: ______%
Employer Survey Satisfaction Rate
**A satisfactory survey must have 24 out of the 28 questions rated 3 or greater on the 5 point Likert Scale.
Employer Satisfactory Surveys: ______
Employer Surveys Returned: ______
Employer Satisfaction Rating: ______%
Completion Date: ______
Employer Survey Return Rate
Employer Surveys Distributed: ______
Employer Surveys Returned: ______
Employer Survey Return Rate: ______%
Employer Survey Satisfaction Rate
**A satisfactory survey must have 24 out of the 28 questions rated 3 or greater on the 5 point Likert Scale.
Employer Satisfactory Surveys: ______
Employer Surveys Returned: ______
Employer Satisfaction Rating: ______%
Completion Date: ______
Employer Survey Return Rate
Employer Surveys Distributed: ______
Employer Surveys Returned: ______
Employer Survey Return Rate: ______%
Employer Survey Satisfaction Rate
**A satisfactory survey must have 24 out of the 28 questions rated 3 or greater on the 5 point Likert Scale.
Employer Satisfactory Surveys: ______
Employer Surveys Returned: ______
Employer Satisfaction Rating: ______%
Completion Date: ______
Employer Survey Return Rate
Employer Surveys Distributed: ______
Employer Surveys Returned: ______
Employer Survey Return Rate: ______%
Employer Survey Satisfaction Rate
**A satisfactory survey must have 24 out of the 28 questions rated 3 or greater on the 5 point Likert Scale.
Employer Satisfactory Surveys: ______
Employer Surveys Returned: ______
Employer Satisfaction Rating: ______%
Completion Date: ______
Employer Survey Return Rate
Employer Surveys Distributed: ______
Employer Surveys Returned: ______
Employer Survey Return Rate: ______%
Employer Survey Satisfaction Rate
**A satisfactory survey must have 24 out of the 28 questions rated 3 or greater on the 5 point Likert Scale.
Employer Satisfactory Surveys: ______
Employer Surveys Returned: ______
Employer Satisfaction Rating: ______%
Completion Date: ______